Timing of injury in the fetus and neonate

Abstract

There is now strong evidence that brain injury commonly occurs in the immediate perinatal period, and so may be potentially treatable.

Cerebral metabolic rate of oxygen and amplitude-integrated electroencephalography during early reperfusion after hypoxia-ischemia in piglets

“…Recent clinical trials have demonstrated that the incidence of death and disability from hypoxia-ischemia in newborns can be significantly reduced by initiating treatment strategies, hypothermia, for example, after birth and within a 6-h therapeutic window (9,11,14,32). Due to the brevity of the therapeutic window, early detection of injury and early determination of those infants who are likely candidates for treatment are crucial (15). In this regard, traditional early indicators of brain injury, including Apgar scores, umbilical artery acidosis, and fetal heart rate monitoring, suffer from poor specificity (7,31), and more specific indicators of injury, such as magnetic resonance imaging and spectroscopy, are insensitive or difficult to implement within the therapeutic window (6,21).…”

An Investigation Into Etiological Pathways of DCD and ADHD Using a Monozygotic Twin Design

“…The current study thus found an association between perinatal oxygen perfusion problems and DCD, as we found previously on a larger study using questionnaire data only (Pearsall-Jones et al, 2008). In our studies it was not clear whether movement difficulties in these twins resulted from perinatal oxygen perfusion problems, or whether, as proposed by Gunn and Bennet (2008), exposure to infections in utero cumulatively sensitized them to hypoxia at birth, or because of prenatal cardiac or lung problems leading to perinatal oxygen perfusion problems (Morley, 2005). In neonatal hypoxic-ischemic encephalopathy, 20-30% of survivors were estimated to have long term neurodevelopmental sequelae, including CP (Vannucci & Perlman, 1997).…”

“…Timing of exposure to infections is important, and may have long-term cumulative effects; for example, increased sensitization to hypoxia at birth and in later life (Gunn & Bennet, 2008). Discordant outcome may also be a result of birth complications and presentation (Bjelic-Radisic et al, 2007) and birth order (Hartley & Hitti, 2005;Smith et al, 2007).…”

Towards Non-Invasive Bedside Monitoring of Cerebral Blood Flow and Oxygen Metabolism in Brain-Injured Patients with Near-Infrared Spectroscopy

“…Due to the brevity of the therapeutic window, early detection of injury and an early determination of those infants who are likely candidates for treatment are crucial (Gunn & Bennet, 2008). In this regard, traditional early indicators of brain injury -including Apgar scores, umbilical artery acidosis and fetal heart rate monitoring -suffer from poor specificity (Carter et al, 1998;Shankaran, 1998) and more specific indicators of injury, such as magnetic resonance imaging and spectroscopy, are insensitive or difficult to implement within the therapeutic window (Cady, 2001;Martin & Barkovich, 1995).…”